Tissue grasping device

ABSTRACT

A tissue grasping device is disclosed having a distal end and a proximal end and a central axis extending from end to end. Three tissue engaging tines are located at the distal end, two of which are rotatable, and one of which is spaced from the other two and slidable lengthwise of the plicator. The tines are parallel to one another and to the main axis of the plicator. Actuating mechanism in the form of rack and pinion mechanisms rotate the rotatable tines relative to one another, to grip a portion of the tissue. The non-rotatable times space the portion of the tissue being operated on from the rotatable tine. A push-pull knob mechanism or a thumb-operated lever is employed at the proximal end of the plicator to slide the non-rotatable tine lengthwise of the device to position it in and out of its operating position.

RELATED APPLICATIONS

This is a continuation-in-part (CIP) application of U.S. applicationSer. No. 08/558,951, filed Nov. 13, 1995, now U.S. Pat. No. 5,722,990,which claims priority to Provisional Application No. 60/006,366 filedNov. 8, 1995, the contents of which are incorporated herein by referencein their entirety.

BACKGROUND OF THE INVENTION

This invention relates in general to tissue manipulating mechanismsuseful in surgery and other medical procedures and, more particularly,to a mechanism for grasping tissue atraumatically.

Most medical gripping devices operate much like a pair of scissors orforceps whereby two jaw members move angularly relative to one anotherabout a pivot axis and come together gradually toward the open end. Atthe pivot end, pinching is positive, while the open end may not cometogether sufficiently to grasp the desired amount of tissue. In otherwords, the jaws come together always at an angle. A considerableadvantage is to be gained by gripping mechanism where the actualelements which engage the tissue come together in parallelism.

Historically, most medical operations have been performed employing the"open" procedure whereby exterior tissue of the patient is opened andpeeled back to expose a relatively large area sometimes including thepatient's organs and the like. With this large operative field, the sizeof surgical instruments is not as important as it is with the newer andmore efficient technique of endoscopic surgery. In the endoscopicprocedure, one or more small openings are made in the exterior tissueand a small light at the end of a fiber optic is inserted along with alens also connected by a fiber optic to a video camera. This permits thesurgeon to view on a scope what he could not otherwise see. Through oneor more additional small openings, the surgeon inserts instruments suchas tissue grasping mechanisms, cutting devices and the like which, bytheir very nature, must be of a small enough diameter to be insertedthrough the small openings. Some of these instruments are expanded whenthey are located inside the patient, whereupon the surgeon performs thenecessary procedures viewing everything on the scope. The instrumentsare then withdrawn and only the small incisions have to be closed. Thus,a tissue grasping device which operates with the grasping elementsoperating in parallel has its value further enhanced if the instrumentis collapsible to be able to be inserted through a small aperture andonce having been located within the patient at the operative field isexpandable to a functional position.

The clamping action of a device which can grasp tissue atraumatically isuseful in numerous medical applications. For example, when searching forair leaks in a lung, tissue is placed under water, by flooding the areawith saline, and then clamped until bubbles are observed to stop. Aclamp of the desired type is easily positioned around the lung for thisprocedure. A line of staples may then be applied to close off theleaking portion of the lung.

If it is desired to roll a portion of a lung in order to plicate orlayer it to receive a line of staples, a composite device having aplurality of parallel tines or gripping elements is desirable. It isadvantageous to grasp the lung tissue with opposable, parallel tines andthen rotate the device to roll the tissue over the tines.

In another application, when applying staples to lung tissue, it isdesirable to remove the air from the tissue as, for example, to collapseit such that a stapler with limited jaw size can be applied.

A grasper having opposable tines is beneficial to this operation byrotating the instrument to squeeze the air out of the lung.

Emphysematous blebs can cause at least two problems. One ispneumothoraces as the bleb leaks and the other is obtrusive disease asthe bleb or emphysematous tissue overfill the chest. Frequently, both ofthese diseases are treated by resuction of the diseased lung or byplication. In the plication technique, the lung tissue is rolled and anon-cutting stapler is placed over the layers of lung held by a clamp. Astapler is positioned over the plicated tissue and the graspingmechanism is withdrawn. The stapler is then fired and the tissue remainsin place but the bleb has been sealed or the volume of the lung has beenreduced without removing any tissue.

One of the largest causes of death in the United States at the presenttime is attributed to the final stages of emphysema. It is generallybelieved that lung volume reduction surgery can be of substantialbenefit in addressing the physiologic problem (air flow limitation).

Lung volume reduction surgery alone is not the answer. Rehabilitation orconditioning programs are limited by air flow reduction to the lungs.The surgery is intended to improve air flow by changing the mechanicalrelationship between the lung, chest, wall and diaphragm which doesresult in improved exercise tolerance. Consequently, lung reductionsurgery is most beneficial to patients who are participating inrehabilitation. It is particularly beneficial to patients withhyperexpanded lungs and chest wall associated with air flow obstruction.

While the present invention contemplates a device having generalsurgical applications, it will be illustrated in lung plication. One ofthe ways to reduce or eliminate the effects of emphysema is to reducethe size of the diseased lung. This can be done by stapling it, i.e.,folding it and then securing it in its folded position. A reduction involume of 30% has been found to be beneficial, particularly whenaccompanied by a reconditioning program. The present invention isdirected to a device for reducing the size of the lung by grasping itwith an atraumatic device, rolling a portion of the lung upon itself andexposing the portion to be stapled.

SUMMARY OF THE INVENTION

The grasping device is a hand-held surgical tool having a distal end anda proximal end and an axis extending from end to end. Lung engagingtines are located at the distal end. Two of the tines are rotatablerelative to each other about axes parallel to the central axis of thedevice and to the third tine which is not rotatable but is constructedto slide axially of the device also parallel to the main axis.

The rotating tines are spaced from each other and from the non-rotatabletine. They are mounted at the ends of rotatable rods in offsetrelationship such that rotation of each rod induces its respective tineto pivot initially away from each other and then are returnable to theiroriginal positions by spring force in substantial engagement with each.Each tine rod mounts a pinion at its proximal end which pinion isengagable with a separate rack. The racks are joined together in aU-shaped frame such that when pressure is applied to the frame againstspring pressure, both tines are rotated away from each other inparallelism into an open position. Subsequent reduction of pressure onthe frame allows springs to return the tines to their original position.

The third tine is non-rotatable but is mounted on a rod which slideslengthwise of the device and may be moved manually into and out of anoperative position in close proximity to the rotatable tines by apush-pull mechanism.

It is also within the scope of this invention that the slidable tine canbe actuated by a rack and pinion mechanism. In this embodiment, the rodwhich mounts the non-rotatable tine has a toothed rack which is engagedby a pinion gear mounted for rotation in the device. The pinion gear isengaged by a finger (or thumb) operated gear also mounted for rotationin the grasping device.

The above and other features of the invention including various andnovel details of construction and combination of parts will now be moreparticularly described with reference to the accompanying drawings andpointed out in the claims. It will be understood that the particulartissue grasping device embodying the invention is shown by way ofillustration only and not as a limitation of the invention. Theprinciples and features of this invention may be employed in varied andnumerous embodiments without departing from the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view partially broken away and partially insection of an atraumatic tissue grasping device embodying the principlesof the present invention.

FIG. 2 is a view on enlarged scale of the end of the device of FIG. 1viewed from the distal end.

FIG. 3 is a top view of the distal end with tines in open position.

FIG. 4 is a top view of the distal end with the tines in closedposition.

FIG. 5 is a side view of the distal end.

FIG. 6 is a top view of the proximal end.

FIG. 7 is a side view of the proximal end.

FIGS. 8 through 14 are a series of schematic views of the device in theprocess of plicating a lung rendered seriatim.

FIG. 15 is a perspective view of another embodiment of the atraumatictissue grasping device of FIG. 1.

FIG. 16 is a perspective view with parts broken away for clarity of theembodiment shown in FIG. 15.

FIG. 17 is a top perspective view with parts broken away for clarity ofthe embodiment shown in FIG. 15.

FIG. 18 is a side view partially in section of the FIG. 15 embodiment.

FIG. 19 is another side view partially in section of the FIG. 15embodiment.

FIG. 20 is a front view of the removable tines in closed position,resulting from the actuating mechanism for moving the tines being in theFIG. 18 position.

FIG. 21 is a front view of the movable tines in the open position,resulting from the actuating mechanism being in the FIG. 19 position.

DETAILED DESCRIPTION OF THE INVENTION

While the invention may be embodied in many devices, it will bedescribed in detail with reference to a lung plicator which will be seenin FIG. 1 in perspective. The device, generally indicated 2, has aproximal end 4, a distal end 6 and a central axis α. Near the distal endis a circular barrel 8 (shown foreshortened and partially broken away inFIG. 1) and near the proximal end is a handle 10. A pair of parallelrotatable tines 12 and 14 extend from the barrel 8 at the distal end. Anon-rotatable, but slidable, tine 16 also extends from the barrel 8 atthe distal end 6. It is parallel to the axis α and the tines 12 and 14and is connected to a rod 17. Operating mechanism for rotating the tines12 and 14 is generally indicated 18, and in located in a housing 19. Thehousing is positioned between the handle 10 and the barrel 8. Anactuator knob 20 projecting from the rod 17 at the proximal end isemployed for sliding the non-rotatable tine 16 manually back and forthlengthwise of the device.

The rotatable tines 12 and 14 are parallel to each other and bothparallel to the axis α. They are respectively offset from operating rods20 and 22 which extend through the barrel and from there to theoperating mechanism 18. The operating rods 20 and 22 mount pinions 24and 26, respectively. The pinions 24 and 26 engage racks 28 and 30projecting downwardly forming the legs of a substantially U-shapedbracket or actuator having a bridge 32, better seen in FIGS. 8, 9 and10. An block 34 is mounted on top of the bridge 32 and projects from thehousing 19. The block moves vertically in the housing 19. Guiding theblock 34 for movement in the direction transversely of the central axisα of the device, are guideways 36 located in the housing 19. Only oneguideway is seen in FIG. 1. Screws 40 secure arcuate guides 42 (only oneof which is seen in FIG. 1) to block 34 for slidable movement in theguideways 36. The guides 42 are urged upwardly by compression springs 44fitting within the guideways 36.

Manually depressing the block 34 causes the racks 28 and 30 to movedownwardly against the force of the compression springs 44. The rodsrotate the pinions 24, 26 in opposite directions. This motion, in turn,rotates the rods 20 and 22, thus causing the tines 12 and 14 to rotatein parallelism about the axis of its own operating rod 20, 22,respectively and outwardly relative to the axis α of the plicator (seeFIG. 2).

Releasing pressure on the block 34 permits the compression springs 44 torotate the pinions 24, 26 in the opposite direction causing the tines 12and 14 to return to their original or closed position.

The plicating device is operated in the following manner. The patient isprepared for surgery in routine fashion. It may be open surgery orendoscopic surgery. If the surgery is endoscopic, an incision is made inthe chest wall and a fiber optic light and camera lens is inserted. Thelight illuminates the operative field and the lens captures an image ofthe interior of the chest cavity which is displayed on a televisionmonitor. A second opening is formed in the chest cavity for theinsertion of the device and a third incision is made for the insertionof a linear stapler. Guiding mechanism such as described in U.S. Pat.No. 5,279,573 to Sugarbaker may be employed to maintain the incisions inopen condition and to align and clamp the fiber optic cable in thedesired position. Similar mechanics may be used to receive the plicatingdevice as well as the stapler.

If open surgery is performed, the fiber optic light the camera lens andthe guiding mechanism are not used. The distal end 6 of the stapler isfirst inserted with the tines 12 and 14 in their closed parallelpositions as shown in FIGS. 2 and 4. The tine 16 may either be in theadvanced position or retracted. If it has been inserted in retractedposition, the next step is seen in FIG. 9 whereupon the knob 20 is urgedforward to extend the tine 16 out of the housing and into spacedparallel relationship to the tines 12 and 14. Thereafter, the block 34is pressed downwardly by the surgeon to rotate the tines 12 and 14 totheir open positions as seen in FIG. 10.

The plicator is next advanced toward the lung L seen in FIG. 11 passingon either side of a portion of the lung designated L_(p). The block 34is then released allowing the springs 44 to rotate tines 12 and 14toward one another. The patient's L_(p) lung is thereby firmly grippedbetween the rotatable tines.

Next referring to FIG. 12, the entire tissue grasping mechanism isrotated in the direction of the arrow in FIG. 12 to roll the lung firstaround the tine 12, subsequently around the non-rotatable tine 16, andthen into contact with the time 14. After rolling is complete, tine 16may be withdrawn from its operative position by pulling on the knob 20leaving the lung gripped between the tines 12 and 14 with a projectionL_(p) in position to be stapled. Alternatively, the tine 16 may remainin place.

The next step is to advance the stapler, shown only partially in FIG.14, as having an anvil portion 60 and a driver 62. The stapler may bepositioned as shown in FIG. 14 with the tine 16 withdrawn. Similarly, itmay be inserted between the tines or even above the tines if the surgeonso desires. The tissue grasping device may be completely withdrawn afterthe stapler is in place since the tissue is then held by the stapler.The stapler is then fired, inserting parallel lines of staples in thelung portion L_(p) while it is in the plicated position. The stapler isnext opened and withdrawn from the patient.

Another embodiment of the invention will be seen in FIG. 15 et sec. Asin the FIG. 1 embodiment, the lung plicator 2 has a proximal end 4, adistal end 6, a central axis α, a circular barrel 8 and a handle or handgrip 10 at the proximal end 4. There are parallel rotatable tines 12 and14 at the distal end and a non-rotatable slidable tine 16 also at thedistal end. As thus far described, the elements are the same as in theFIG. 1 embodiment.

Referring next to FIGS. 16 to 19, mechanism for advancing and retractingthe non-rotatable slidable tine 16 will be described. A rod 70 is alinear extension of the tine 16 and is guided for movement in the barrel8 in guideways 72 and 74 (FIG. 16). The proximal end of the rod 70 has arack 74 with a linear array of teeth 76. The teeth are engagable with apinion gear 78 which is mounted for rotation in the handle 10 on stubbyshafts 80. The pinion 78 is engaged by a finger operated driving gear 82also mounted for rotation in the handle 10 on stubby shafts 84. As willbe seen in FIG. 16, rotation of the driving gear 82 in the direction ofthe arrow 86 in FIG. 16 causes the pinion gear 78 to rotate in theopposite direction, thus moving the toothed rack, the rod 70 and, thus,the non-rotatable tine out of the guideway 72 in the barrel 8 in thedistal direction. Opposite rotation of the driving gear 82 withdraws thenon-rotatable tine 16 back toward and into the housing 8.

The extending mechanism thus described for moving the non-rotatable tine16 toward and away from the distal end 6 parallel to the axis α and therotatable tines 12 and 14 is the equivalent of the push-pull mechanismincluding the rod 17 and the actuator knob 21 of the FIG. 1 embodiment.

Another embodiment shown in FIGS. 15-21 is the mechanism for rotatingthe tines 12 and 14 in arcs. As in the FIG. 1 embodiment, movable tine12 is secured in offset relationship to an operating rod 20 and themovable tine 14 is connected also in offset relationship to an operatingrod 22.

A thumb actuated lever 90 is pivoted on a pin 92 in the handle portion10 of the device or tool 2. One end of the lever 90 has a thumb rest 94and the opposite end 96 is generally fan-shaped and has outwardlyextending noses 98, each of which is provided with a slot 100. Theoperating rod 22 is provided with an offset crank 102 as is the rod 22.The cranks 102 (one of which is best seen in FIG. 16) includes a segment104 extending outwardly from the rod 22 and a terminal portion 106 whichextends parallel to the rod 22. Portions 106 are received within theslots 100 in the noses 98 of the thumb lever 90.

In the rest position, the lever occupies the position shown in FIG. 18with the thumb portion 94 of the lever 90 being elevated by a leafspring 108 fixed in the handle 110 and engagable with the bottom of thelever 90. In the rest position, the tangs 12 and 14 occupy the positionshown in FIG. 20, that is, the closed position. To open the tangs, thesurgeon presses on the finger portion 94 of the lever 90 against theforce of the spring 108 and, through the linkage 102 and the rods 22,moves the tines 12 and 14 to the FIG. 21 position. Release of the leverpermits the spring 108 to return the lever 92 to the FIG. 18 position.

The FIG. 15 embodiment of the device is operated to perform the samefunctions that were described with reference to the FIG. 1 embodiment.

The invention claimed is:
 1. A surgical device comprising:a tissuemanipulating mechanism having a proximal end and a distal end; at leasttwo rotatable, parallel, tissue engaging tines extending from the distalend of the mechanism and movable in arcs toward and away from each otherin parallelism; a non-rotatable tine extendable from the distal end in alinear path parallel to the movable tines; extending mechanism connectedto the non-rotatable tine for moving said non-rotatable tine toward andaway from the distal end parallel with the rotatable tines; andactuating mechanism connected to the movable tines for moving saidmovable tines in arcs.
 2. A surgical device according to claim 1,wherein the actuating mechanism comprises manually operated rack andpinion gears.
 3. A surgical device according to claim 2, wherein theactuating mechanism is a finger operated lever pivotally mounted at theproximal end and engagable with the rack and pinion gears.
 4. A surgicaldevice according to claim 1, wherein the extending mechanism is amanually operated push-pull device.
 5. A surgical device according toclaim 1, wherein the extending mechanism is a finger operated gear andpinion engagable with a rack on the non-rotatable tine.
 6. A surgicaldevice comprising:a tissue manipulating mechanism having a central axis,a proximal end and a distal end; at least one, rotatable, tissueengaging tine extending from the distal end and movable in an arc inparallelism with the axis; a non-rotatable tine movable linearly fromthe proximal end toward and away from the distal end in parallelism withthe axis; actuating mechanism connected to the at least one rotatabletine for rotating said one rotatable tine in an arc toward and away fromthe non-rotatable tine for releasably gripping and manipulating tissue.7. A surgical device according to claim 6, wherein the actuatingmechanism comprises manually operated rack and pinion gears.
 8. Asurgical device according to claim 6, wherein the actuating mechanism isa finger operated lever pivotally mounted at the proximal end andengagable with the rack and pinion gears.
 9. A surgical devicecomprising:a tissue manipulating mechanism having a central axis, aproximal end and a distal end; at least two rotatable, tissue engagingtines extending from the distal end and movable in arcs in parallelismwith the axis and with each other; a non-rotatable tine movable linearlyfrom the proximal end toward and away from the distal end in parallelismwith the axis; extending mechanism connected to the non-rotatable tinefor moving said non-rotatable tine toward and away from the distal endparallel with the rotatable tines; and actuating mechanism for rotatingsaid rotatable tines in arcs toward and away from the non-rotatable tinefor releasably gripping and manipulating tissue.
 10. A surgical deviceaccording to claim 9, wherein the actuating mechanism comprises manuallyoperated rack and pinion gears.
 11. A surgical device according to claim10, wherein the actuating mechanism is a finger operated lever pivotallymounted at the proximal end and engagable with the rack and piniongears.
 12. A surgical device according to claim 9, wherein the extendingmechanism is a manually operated push-pull device.
 13. A surgical deviceaccording to claim 9, wherein the extending mechanism is a fingeroperated gear and pinion engagable with a rack on the non-rotatabletine.
 14. A surgical device comprising:a tissue manipulating mechanismhaving a proximal end and a distal end; at least two rotatable,parallel, tissue engaging tines extending from the proximal end of themechanism and movable in arcs toward and away from each other inparallelism; a non-rotatable tine extendable from the distal end in alinear path parallel to the movable tines; extending mechanism formoving the non-rotatable tine toward and away from the distal endparallel with the rotatable tines; actuating mechanism for moving themovable tines in arcs; and a hand grip at the proximal end of the devicemounting the extending mechanism and the actuating mechanism.
 15. Asurgical device according to claim 14, wherein the actuating mechanismcomprises manually operated rack and pinion gears.
 16. A surgical deviceaccording to claim 15, wherein the extending mechanism comprises a rackformed on the proximal end of the non-rotating tine, a pinion gearengagable with the rack and a hand-operated driving gear engagable withthe pinion.
 17. A surgical device according to claim 14, wherein theextending mechanism is a manually operated push-pull device.
 18. Asurgical device according to claim 14, wherein the extending mechanismcomprises: a rack formed on the proximal end of the non-rotating tine, apinion gear engagable with the rack and a hand-operated driving gearengagable with the pinion.